Vesicouterine fistula with vesical calculi secondary to IUD migration: a case report.

BACKGROUND

Intrauterine device (IUD) migration leading to vesicouterine fistula (VUF) with vesical calculi is rare. This case is notable due to the absence of typical Youssef’s syndrome symptoms and the insidious presentation of a Type III VUF, complicating timely diagnosis. A 31-year-old woman with a 10-year history of a migrated "T-shaped" IUD presented with lower abdominal pain. Initial hysteroscopy failed to detect the IUD, but ultrasound revealed a bladder foreign body. Computed tomography urography (CTU) and cystoscopy confirmed a VUF (1 cm diameter) and a 3 cm vesical calculus encasing the IUD. Notably, she lacked cyclic hematuria or vaginal urination but experienced transient hematuria after placement of a catheter. INTERVENTION AND OUTCOME: Laparoscopic vesicouterine fistula resection, bladder and uterine repair, and IUD removal were performed. Vesical calculi were fragmented via holmium laser lithotripsy. Postoperative imaging at 3, 9, and 12 months confirmed fistula resolution, no calculi recurrence, and restored menstrual regularity. CONCLUSION WITH CLINICAL RELEVANCE: Type III VUF without urinary leakage poses diagnostic challenges. IUD displacement into the bladder warrants suspicion for VUF, even in asymptomatic patients. Laparoscopic repair is effective, emphasizing complete fistula excision and scar tissue removal. Annual gynecological surveillance is critical for IUD users to prevent complications.